10.5061/DRYAD.32C2QH4
Malhotra, Konark
West Virginia University
Ishfaq, Muhammad Fawad
University of Tennessee Health Science Center
Goyal, Nitin
University of Tennessee Health Science Center
Katsanos, Aristeidis H.
University of Ioannina
Parissis, John
National and Kapodistrian University of Athens
Alexandrov, Anne W
University of Tennessee Health Science Center
Alexandrov, Andrei V.
University of Tennessee Health Science Center
Tsivgoulis, Georgios
National and Kapodistrian University of Athens
Data from: Oral anticoagulation in patients with chronic kidney disease: a
systematic review and meta-analysis
Dryad
dataset
2019
Chronic kidney disease
oral anticoagulants
cerebrovascular disease/ Stroke
2019-05-17T16:51:29Z
2019-05-17T16:51:29Z
en
https://doi.org/10.1212/WNL.0000000000007534
1312411 bytes
1
CC0 1.0 Universal (CC0 1.0) Public Domain Dedication
Objective: Data regarding the efficacy and safety of warfarin and
Non-Vitamin K Antagonist Oral Anticoagulant (NOAC) among patients with
chronic kidney disease (CKD) remain scarce. Methods: Systematic review and
meta-analysis of studies involving CKD patients treated on OACs was
conducted to evaluate following outcomes: ischemic stroke, intracerebral
hemorrhage (ICH), combined ischemic and hemorrhagic stroke
(strokecombined), stroke or systemic embolism, mortality, and major
bleeding events. CKD was defined based on creatinine clearance (CrCl)
ranging from mild (CrCl: 60-89 ml/min), moderate (CrCl: 30-59 ml/min) and
severe (CrCl: 15-29 ml/min). Results: Fifteen studies (7 comparing NOAC
vs. warfarin & 8 comparing warfarin vs. no anticoagulant) were
identified comprising 87,291 patients. Warfarin (vs. no anticoagulant) was
associated with reduced risk of ischemic stroke [RR=0.68 (95%CI:
0.55-0.84)] and mortality [RR=0.70 (95%CI: 0.62-0.78)]. In comparison to
warfarin, NOAC use lowered the risk of ICH [RR=0.43 (95%CI: 0.33-0.56)],
strokecombined [RR=0.83 (95%CI: 0.72-0.96)], stroke or systemic embolism
[RR=0.73 (95%CI: 0.62-0.85)] and major bleeding [RR=0.77 (95%CI:
0.66-0.90)]. In adjusted analyses, warfarin use (vs. no anticoagulant) was
associated with reduced mortality [HRadj=0.68 (95%CI: 0.61-0.76)], whereas
NOAC (vs. warfarin) use reduced the risk of ICH [HRadj=0.39 (95%CI:
0.30-0.50)] and stroke or systemic embolism [HRadj=0.75 (95%CI:
0.65-0.88)]. Our sensitivity analyses comparing different NOACs exhibited
that factor Xa inhibitors (compared to warfarin) consistently reduced
strokecombined [RR=0.84 (95%CI: 0.73-0.96)], mortality [RR=0.84 (95%CI:
0.70-1.00)], ICH [RR=0.45 (95%CI: 0.24-0.85)] and major bleeding [RR=0.76
(95%CI: 0.64-0.91)]. Conclusions: Amongst CKD patients treated with OAC,
NOACs present with a more favorable safety and efficacy profile for
various cardiovascular outcomes.
Online supplementSupplemental file